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DocuSign Envelope ID:9CBAA6B1-266B-4426-BDCC-20AAE9B937EF <br /> /4009 CAçi <br /> 0 <br /> ct- pi: (Fs <br /> 0 Z <br /> Z 011° <br /> a <br /> l@Tio . 201718 <br /> GRASSROOTS ARTS PROGRAM <br /> 1011ANIOE COUNTY ARTS <br /> commismN <br /> iw.ncarLscrg APPLICATION FORM <br /> PART 1; APPLICATION ORGANIZATION INFORMATION <br /> Organizet on Name: Town of Chapel HIP Parks&Reoreation Department(CultiJrall Arts Divi5 ilop)185, <br /> Street Address:200 Rani Rd. „ <br /> City:Chapel HU Staite:NC Zip:2(514 <br /> Phone:919-968-2750 Welbstte: <br /> Authorizing Official N,arne:Jim Orr <br /> Authorizing Official Title: Diractor <br /> Authorizing Official Phone 9199%275 , Authorizing Official Email:jonglowdotohapelnill org <br /> Applicant Race: Organization EIN: <br /> ORGANIZATIONAL FINANCES <br /> Please attach a complete income and expense statement (an audit may be substituted) for your last fiscal year and <br /> complete operating budgets for the current fiscal year and next fiscal year, Public schools arid other large governmental or <br /> community agencies should attach arts program financial information only. Please copy the totals from these attachments <br /> in the spaces bellow <br /> Last Year Actual: FY15-16 Current Year FY16-17 Next Year: FY17-16 <br /> Actual Income: $578413 Projected Income:_$&3242 Projected Income: $566,711 <br /> Actual Expenses: $561,694 Projected Expense $573031 Projected Expense: $565,711 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATIO1',Iiki different froni Authorizing Official) <br /> Project Director Name:Jeffrey J York <br /> Project Director Title:Public&Cultural Ads Administrator - --- <br /> Street Address:200 Plant Rd. <br /> CRT,Chap,e1 Hill State:NC j Zip:27514 <br /> Phone:919-988-2750 1 Email:jyork@townolchziolhillorg <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project:Shimmer:The Art of Light <br /> Grant Amount Requested:$3,000 <br /> Project Start Date(No earlier than July 1, 2017):February 2018 <br /> Project End Date (No later than June 30, 2016):February 2018 <br /> SCHOOLS ONLY", <br /> Are you booking your artists through The ArtsCenters Arts in Schools Program? 0 YES 0 NO <br />